Description

Position Summary

An exempt position responsible for oversight of the following functions: 

• Eligibility/Pre-Certification
• Financial Counseling, Estimates and Collections
• Clinical Documentation, Charge Entry, Coding, Charge Review, Reconciliation
• Maintenance of Charge Master and Payer Fee Schedules
• Claims Billing, Payer Remit and Payment Posting, Payment Validation, Denials Management, Accounts Receivable Management

The Revenue Cycle Manager reports to the CEO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. The Manager will oversee the policies, objectives, and initiatives of all revenue cycle activities to optimize the patient financial interaction along the care continuum achieving best practice performance using HFMA Map Key indicators.

 This position is currently a temporary position with the potential for permanent hire after an interim probationary period. This probationary interim period can last up to 90 days but may be extended based on position and candidate.

Requirements

Principal Duties and Responsibilities:

1. Develop and implement revenue cycle policies and procedures to ensure efficient and effective operations.
2. Oversee and support the daily operations of across all revenue cycle functions: front, middle and end.
3. Work closely with other departments including clinical operations, information technology, nursing and ancillary departments to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting receivables.
4. Oversee work schedule and direct changes in priorities and schedules as needed to assure work is completed in an efficient and timely manner and to improve the department’s performance and service.
5. Direct the selection, supervision, and evaluation of staff. Ensure performance evaluations are conducted in a timely manner according to organizational policy with career planning, coaching for excellence and performance improvement plans ensuring high performance across the revenue cycle continuum. 
6. Oversee orientation and continuing education for all staff. Ensure mandatory and relevant training is provided to staff in a timely manner.
7. Implement a Quality Assurance program for key functions and monitor staff and team performance, including vendors when outsourced functions, making changes, when required, to support high performance and compliance.
8. Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial or Executive Officer.
9. Collaborate with front end Revenue Cycle coordinators/managers to collaborative including planning, organizing, and delivering on key projects designed to reach high performance KPIs.
10. Assist with the development of budgets and monitoring of department operations to achieve goals within budget.
11. Respond personally to concerns and/or complaints expressed by patients, visitors, staff, and physicians in effort to support optimal operations and excellent customer service.
12. Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
13. Maintain appropriate internal controls for the safeguarding of cash.
14. Provide leadership, guidance, and support to the revenue cycle team. Resolve grievances and other sensitive personnel matters.
15. Follow and monitor compliance with organizational policies and standards.
16. Develop, redesign, and monitor key performance indicators across the HFMA Map Key domains: Patient Access, Pre-Billing, Claims, Account Resolution, and Financial Management.
17. Monitor key performance indicators (KPIs) and implement strategies to optimize revenue cycle processes to improve efficiency and reduce costs.
18. Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
19. Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.

20. Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.

21. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks. Verify appropriate collections procedures are being followed.

22. Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors.

23. In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.

24. Monitors daily productions of scheduling, claims, denials, and appeals.

25. Analyzes claims, utilization, and medical cost data.

26. Reviews, monitors, and recommends updates to the Clinic’s fee schedule to maintain fees at levels that maximize reimbursement.

27. Ensures compliance with relevant federal, state, and payor-specific billing requirements.

28. Regularly provides upper management with revenue cycle status including reports, metrics, and presentation.

29. Ensure staff are educated on new technology, goals, and contracts.

30. Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.

31. Work with Managed Care vendors in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time.

32. Additional projects, goals, issues surrounding the revenue cycle, conflicts, or concerns as directed or indicated by Administration.

Required Skills, Knowledge, and Abilities

• Expert knowledge of patient financial services (PFS) processes and standards including scheduling, registration, eligibility, medical records, finance, data processing, coding, documentation, claims submission, collections, and cash posting.
• Expert knowledge of driving best practice performance through continuous process improvement and automation. 
• Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid Commercial and managed care processes.
• Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, patients, and the public.
• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.
• Outstanding ability to work independently to achieve results. Often, there is no precedent for and little help in carrying out assigned tasks. Must originate, plan, adapt and invent to accomplish tasks.
• Ability to set and maintain priorities when dealing with multiple demands and interruptions.
• Strong analytical and problem-solving skills.
• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
• Excellent customer service skills.
• Intermediate computer skills including email, word processing, spreadsheets, and working with graphics.

Education

• Required: Bachelor’s degree in business, accounting, finance, or related field.
• Master’s degree in business, accounting, finance, or related field preferred.

Experience

• Minimum five years of mid to senior leadership-level experience in physician enterprise or medical group revenue cycle management
• Strong understanding of medical billing, coding, and reimbursement processes
• Proven track record of improving revenue cycle performance and reducing accounts receivable.
• Excellent leadership, communication, and interpersonal skills
• Ability to analyze data and make data-driven decisions.
• Strong problem-solving and critical thinking skills
• Knowledge of relevant federal, state, and local regulations related to billing and collections.
• Proficiency in Microsoft Office Suite and revenue cycle management software
• Prefer experience working with Greenway/Intergy and Waystar software experience.

Other Requirements

• Current HFMA Certification or ability to obtain within 6 months of hire.

Working Conditions

OSHA Category 3: Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.

The position is in a well-lit office environment. Occasional evening and weekend work. Involves sitting, walking, or standing throughout the day. Equipment operated will be standard office equipment including computers, fax machines, copiers, printers, telephones, etc.